Outcomes of Kidney Transplantation from Deceased Donors with Severe Acute Kidney Injury (AKIN Stage 3): A Preliminary Single-Centre Analysis.

IF 4.4 Q1 Medicine

Medical sciences (Basel, Switzerland) Pub Date : 2025-09-14 DOI:10.3390/medsci13030188

Juan A Encarnación, Elisabeth Coll, Clara Manso, Santiago Llorente, Francisco Morales, Isabel Saura, Pedro López-Cubillana, Pablo Luis Guzman Martínez-Valls, Gloria Martínez, Isabel De la Fuente, Enrique Cárdenas, Jose L Alonso-Romero, Paula Ruiz, José Moya, Beatriz Domínguez-Gil, Mario Royo-Villanova

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Abstract

Background: The shortage of donor kidneys has prompted interest in using organs from donors with severe acute kidney injury (AKI), but robust data on outcomes from donors with AKIN stage 3 remain limited.

Methods: This single-centre, retrospective cohort study compared outcomes of kidney transplants from deceased donors with AKIN stage 3 AKI to matched non-AKI donors (n = 57 per group; matched by donor age ±5 years, year of transplant, and major cardiovascular risk factors). Primary outcomes were delayed graft function (DGF), death-censored graft survival, and patient survival. Secondary outcomes included renal function at follow-up.

Results: DGF occurred in 54.4% (31/57) of AKIN 3 recipients vs. 33.3% (19/57) of non-AKI recipients (risk difference 21.1%, 95% CI 3.1-39.2; p = 0.037). Five-year death-censored graft survival was 94.7% vs. 96.4% (HR 1.28, 95% CI 0.25-6.52; p = 0.645). Five-year patient survival was 84.8% vs. 84.0% (HR 0.96, 95% CI 0.30-3.05; p = 0.979). Median follow-up was 32 months.

Conclusions: In this preliminary, selected kidneys from AKIN stage 3 donors yielded similar medium-term graft and patient survival to non-AKI donors, despite higher DGF incidence. Findings should be interpreted cautiously and confirmed in adequately powered, multicentre studies with extended follow-up.

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严重急性肾损伤的死亡供者肾移植的结果（AKIN期3）：一项初步的单中心分析。

背景：供体肾脏的短缺引起了人们对使用严重急性肾损伤（AKI）供体器官的兴趣，但关于AKIN 3期供体结果的可靠数据仍然有限。方法：这项单中心、回顾性队列研究比较了患有AKIN 3期AKI的已故供者与匹配的非AKI供者的肾移植结果（每组n = 57，匹配供者年龄±5岁、移植年份和主要心血管危险因素）。主要结局是延迟移植物功能（DGF），死亡审查的移植物生存和患者生存。次要结局包括随访时的肾功能。结果：54.4%（31/57）的AKIN 3受体发生DGF，而33.3%（19/57）的非aki受体发生DGF（风险差异21.1%,95% CI 3.1-39.2; p = 0.037）。5年死亡审查后的移植物存活率为94.7%比96.4% （HR 1.28, 95% CI 0.25-6.52; p = 0.645）。患者5年生存率为84.8%比84.0% （HR 0.96, 95% CI 0.30-3.05; p = 0.979）。中位随访时间为32个月。结论：在这项初步研究中，尽管DGF发生率更高，但来自AKIN 3期供者的肾脏与非aki供者的中期移植和患者生存率相似。研究结果应谨慎解释，并在充分有力的多中心研究和长期随访中得到证实。

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